| NPI | 1386873560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP70002653) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010129) |
| 111NN0400X Chiropractor, Neurology (Licence: WA CH60618003) | |
| 111N00000X Chiropractor (Licence: FL CH9778) | |
| 111N00000X Chiropractor (Licence: WA CH 60618003) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2026-04-08 |